Clinical and Patohistological Factors Affecting the 5 Year Survival Rate in a Population of Croatian Women with Invasive Ductal Breast Carcinoma

Breast carinoma falls into a heterogeneous group of diseases which can be determined by various prognostic factors. The identification of clinical and histopathologic factors is of great value in predicting the progression of tumor growth and survival outcome. Due to a high degree of cell proliferation in breast tumors and high genetic instability of these tumors, as a consequence of defective DNA repair mechanisms, chemotherapy as a treatment option often renders very successful results. During our scientific study of the expression of genes responsible for mismatch repair of DNA in cells of invasive ductal carcinoma we also compared the patient survival rate with the major prognostic factors. This study included 108 patients who were surgically treated for invasive breast cancer at the Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital »Dubrava«. The overall survival rate was compared to factors such as initial tumor stage, regional lymph node involvement and distant metastasis. The overall five year survival rate of our patients was 78,7%. Patients without the presence of distant metastasis, a lower rate of local lymph node involvement and a lower tumor stage statistically had a longer overall survival period. It is important that physicians recognize the various clinico- pathohistological factors in patients with breast carcinoma. This study confirms that this prognostic factors determine the type of treatment required and most important, the patient overall survival period

Rekonstrukcija defekata skalpa i kalvarije

Defects of the scalp and calvaria most frequently occur as a result of invasive growth of intra- or extracranial malignant or benign tumors, or as a result of trauma. During a five-year period, from 2004 to 2008, 21 patients (12 men and 9 women) underwent reconstructive surgery for scalp and calvaria defects at the Department of Plastic Surgery, “Dubrava” University Hospital. The patients were divided into groups with regard to the etiology of the defect, size, depth, reconstruction technique, number of surgical procedures, complications and duration of hospitalization. Different local flaps were successfully used for reconstruction of small and medium-sized defects of the scalp and calvaria, while large defects were reconstructed using free microvascular flaps. Successful treatment of the scalp and calvaria defects depends on accurate indication and the choice of an appropriate reconstruction technique.Defekti skalpa i kalvarije najčešće su posljedica invazivnog rasta intra- ili ekstrakarnijalnih zloćudnih ili dobroćudnih tumora ili traume. Tijekom petogodišnjeg razdoblja, od 2004. do 2008. godine, u Klinici za plastičnu kirurgiju KB Dubrava 21 bolesnik (12 muškaraca i 9 žena, srednja dob - 61 godina) bio je podvrgnut rekonstrukcijskom kirurškom zahvatu zbog defekata sklapa i kalvarije. Bolesnici su podijeljeni u skupine s obzirom na etiologiju defekta, veličinu, dubinu, reksontrukcijski postupak, broj kirurških zahvata, komplikacije i trajanje hospitalizacije. Za male i srednje velike defekte skalpa i kalvarije uspješno su korišteni različiti lokalni režnjevi, a za velike defekte slobodni mikrovasularni režnjavi. Uspjeh zbrinjavanja ovih defekata skalpa i kalvarije ovisi o pravilnoj indikaciji i izboru adekvatne kirurške tehnike za rekonstrukciju

Rekonstrukcija defekata skalpa i kalvarije

Defects of the scalp and calvaria most frequently occur as a result of invasive growth of intra- or extracranial malignant or benign tumors, or as a result of trauma. During a five-year period, from 2004 to 2008, 21 patients (12 men and 9 women) underwent reconstructive surgery for scalp and calvaria defects at the Department of Plastic Surgery, “Dubrava” University Hospital. The patients were divided into groups with regard to the etiology of the defect, size, depth, reconstruction technique, number of surgical procedures, complications and duration of hospitalization. Different local flaps were successfully used for reconstruction of small and medium-sized defects of the scalp and calvaria, while large defects were reconstructed using free microvascular flaps. Successful treatment of the scalp and calvaria defects depends on accurate indication and the choice of an appropriate reconstruction technique.Defekti skalpa i kalvarije najčešće su posljedica invazivnog rasta intra- ili ekstrakarnijalnih zloćudnih ili dobroćudnih tumora ili traume. Tijekom petogodišnjeg razdoblja, od 2004. do 2008. godine, u Klinici za plastičnu kirurgiju KB Dubrava 21 bolesnik (12 muškaraca i 9 žena, srednja dob - 61 godina) bio je podvrgnut rekonstrukcijskom kirurškom zahvatu zbog defekata sklapa i kalvarije. Bolesnici su podijeljeni u skupine s obzirom na etiologiju defekta, veličinu, dubinu, reksontrukcijski postupak, broj kirurških zahvata, komplikacije i trajanje hospitalizacije. Za male i srednje velike defekte skalpa i kalvarije uspješno su korišteni različiti lokalni režnjevi, a za velike defekte slobodni mikrovasularni režnjavi. Uspjeh zbrinjavanja ovih defekata skalpa i kalvarije ovisi o pravilnoj indikaciji i izboru adekvatne kirurške tehnike za rekonstrukciju

Chondromyxoid Fibroma of the Second Metacarpal Bone – A Case Report

This report describes a chondromyxoid fibroma of the second metacarpal bone in a 32-year-old female patient. Chondromyxoid fibroma is a rare, benign, slow-growing bone tumor of cartilaginous origin. Tumor has a high recurrance rate. Our aim was to show successful treatment of a metacarpal chondromyxoid fibroma with wide resection and implantation of finger join endoprosthesis

The importance of intraoperative touch smears cytology in the nipple sparing mastectomy

Karcinom dojke je jedan od najraširenijih malignih tumora u žena, češće je duktalnog nego lobularnog podrijetla. Nalazi se na prvom mjestu i po pojavnosti i po mortalitetu. Vrlo je važno što ranije otkriti bolest jer dijagnosticiranje karcinoma u početnom stadiju jamči bolje izlječenje. Postoji mnogo dijagnostičkih metoda. Citološka punkcija pod nadzorom ultrazvuka i core biopsija imaju veliku ulogu u ranom otkrivanju bolesti i boljem preživljenju. Velik broj pacijentica operiran je poštednom operacijom zahvaljujući ranom otkrivanju karcinoma. Mastektomija se obično radi u pacijentica s multicentričnim, velikim ili ponovljenim tumorom nakon konzervativne terapije. Ponekad se mastektomija s poštedom kože i bradavice radi kod pacijentica s pozitivnim genom BRCA-1 i BRCA-2. U 5 do 10% pacijentica s karcinomom dojke tumorske se stanice mogu otkriti u bradavici. Intraoperacijska citološka analiza otiska baze mamile vrlo je važna i točnost ovisi o pravilno označenom dijelu bradavice (najvažnije je dobro označavanje vanjske i unutarnje površine bradavice) i znanju citologa. Tijekom jedne godine od 9. studenoga 2010. do 10. studenoga 2011. napravljena je mastektomija s poštedom bradavice u 47 pacijentica. Usporedbom hitne citološke i konačne patohistološke dijagnoze, citološka je dijagnoza pokazala specifičnost 97%, osjetljivost 85% i dijagnostičku točnost 91%. Moramo biti oprezni u interpretaciji rezultata zbog pukotina u smrznutim hitnim patohistološkim rezovima i sklonosti malignih stanica grupiranju, kao i kod nekrotičnih citoloških otisaka u kojima mogu biti skrivene i razorene maligne stanice. Intraoperacijska analiza omogućuje rekonstrukciju dojke tijekom iste operacije.Breast cancer is one of the most widespread malignant tumours in women, more commonly of ductal than lobular origin. It also has the highest incidence and mortality rates. Early detection is very important since breast cancer diagnosis in the initial stages guarantees better outcomes. There are many diagnostic methods. Ultrasound-guided cytological puncture and core biopsy have a major role in early detection of this disease and better chances of survival. A large number of patients had breast-conserving surgery thanks to the early detection of cancer. Mastectomy is usually performed on patients with multicentric, large or recurrent tumours after conservative treatment. Sometimes skin-sparing and nipple-sparing mastectomy is performed on patients with positive BRCA-1 and BRCA-2 genes. Tumour cells can be detected in the nipple in 5-10% of patients with breast cancer. Intraoperative cytologic analysis of the nipple-areola complex imprint is very important and the accuracy depends on the properly marked part of the nipple (the most important step is to properly label the inner and outer surface of the nipple) and the skill of the cytologist. Over the course of one year, from 9 November 2010 to 10 November 2011, 47 patients had nipple-sparing mastectomy. The comparison of the cytologic and final histopathological diagnosis showed that cytological diagnosis had 97% specificity, 85% sensitivity and 91% diagnostic accuracy. We need to exercise caution in the interpretation of results due to cracks in frozen urgent histopathological cuts and the grouping tendency of malignant cells, as well as necrotic cytologic imprints which can contain hidden and destroyed malignant cells. Intraoperative analysis allows for breast reconstruction during the same surgical procedure

TRENDS IN STAGE AND AGE CHARACTERISTICS OF THE FEMALE BREAST CANCER TREATED IN 11-YEAR PERIOD AT UNIVERSITY HOSPITAL »DUBRAVA«

U retrospektivnoj studiji analizirali smo i usporedili faktore lokalne proširenosti raka dojke, odnosno veličinu tumora i status regionalnih limfnih čvorova u razdoblju od 1997. do 2007. Također smo uspoređivali zastupljenost pojedinih dobnih skupina i prosječnu dob bolesnica u promatranom razdoblju. Studijom su obuhvaćene samo one bolesnice kod kojih je dijagnoza postavljena na otvorenoj kirurškoj biopsiji, a bilo je moguće odrediti lokalnu proširenost tumora u vrijeme postavljanja dijagnoze (pT i pN stadij), ukupno 1202 bolesnice. Prosječna veličina tumora u vrijeme postavljanja dijagnoze bila je 2,2 cm, a kretala se između 1,7 cm (2005.) i 2,4 cm (1997., 1999.). Učestalost metastaza u pazušnima limfnim čvorovima varirala je između 37% (2001.) i 50% (2000. i 2006.). Prosječno u 6% svih slučajeva rak dojke dijagnosticiran je u neinvazivnom (in situ)stadiju. Srednja dob bolesnica bila je 56,8 godina, a prema promatranim godinama kretala se između 54,3 (1999.) i 59,1 (2004.) godina. Nije bilo statistički značajne razlike u odnosu prema stadiju bolesti ili dobi bolesnica u vrijeme postavljanja dijagnoze u cijelome promatranom razdoblju. Isto tako nije bilo statistički značajnih razlika u proširenosti bolesti u vrijeme dijagnoze kod bolesnica mlađih i starijih od 50 godina.In a retrospective study we analyzed and compared the factors of local spread of breast cancer, namely tumor size and status of regional lymph nodes and patient age in the period from 1997 to 2007. The study includes only those patients in whom the diagnosis was made in an open surgical biopsy and it was possible to determine the local extent of disease at the time of diagnosis (pT and pN stage), a total of 1202 patients. We also compared the findings in patients younger and older than 50 years. The average tumor size at diagnosis was 2.2 cm and ranged between 1.7 cm (2005) and 2.4 cm (1997, 1999). The percentage of metastases in regional lymph nodes varied between 37% (2001) and 50% (2000 and 2006). The average of 6% of all cases of breast cancer was diagnosed in non-invasive (in situ) stage. The mean patient age was 56.8 years and for the observed age ranged between 54.3 (1999) and 59.1 (2004) years. There was no statistically significant difference in relation to disease stage or patient age at diagnosis observed throughout the entire period of time. There was also no statistical difference in stage of disease at the time of diagnosis in patients younger and older than 50 years

SUSTITUTE AND ALTERNATIVE FORMS OF TREATMENT OF SKIN DEFECTS

Gubitak kožnog pokrova ima različite uzroke te zahtijeva pokrivanje defekta da bi se smanjile posljedice i komplikacije, te produljenje hospitalizacije uz povećanje troškova liječenja. Standarne plastično rekonstrukcijske metode često nisu moguće ili su prekompleksne, tako da alternativni oblici liječenja koji uključuju zamjene za kožu imaju važnu ulogu.Damage to skin barrier has different causes, and in case of prolonged exposure without expeditious coverage it entails consequences such as prolonged hospitalization and higher treatment costs. Standard plastic reconstructive techniques of coverage are not always possible, so alternative skin coverage techniques have an important role in treatment

SURGICAL EXPERIENCES IN THE TREATMENT OF ULCER COMPLICATIONS

Potkoljenični vrijed je učestala bolest u općoj populaciji koja ima za posljedicu znatan morbiditet. Poseban problem je široka diferencijalna dijagnoza što se etiologije tiče tako da uzrok može biti metabolički, imunološki, vaskularni, onkološki ili miješani. Pristup liječenju je multidisciplinaran. Uz niz uključenih medicinskih struka kirurgija je bitan faktor u liječenja komplikacija vrijeda, postoji niz učinkovitih zahvata koji uz pravu indikaciju imaju za ishod cijeljenje . Uz plastično rekonstrukcijske metode postoji i niz komplementarnih metoda uglavnom iz domene vaskularne kirurgije kojima se optimizira lokalno i regionalno stanje te poboljšava rezultat liječenja.Lower leg ulcers have a high in incidence in general population and are associated with a significant morbidity rate. Wide differential diagnosis considering their etiology poses considerable problem, as the causes are diverse including metabolic, immune, oncologic, vascular and mixed ones. Approach to treatment should be multidisciplinary, and among various medical specialties surgery plays an important role. There are numerous efficient procedures that require proper indication to be successful. Along with reconstructive methods, there are complementary methods, mainly from the field of vascular surgery; when combined, they produce good results